Polonnaruwa combats CKD with ‘clean’ drinking water

A silent killer, sneaking upon its victims systematically, and trouncing at the stage where their kidneys are beyond repair, CKDu was first diagnosed in Sri Lanka in the early 1990s. The disease reached epidemic levels, where a Presidential Task Force was appointed to address the issue. According to the statistics of the Epidemiology Unit of the Ministry of Health, Nutrition and Indigenous Medicine between January 2010 and December 2015 there had been 29,662 patients diagnosed with CKD/CKDu in 50 government hospitals around the country. Moreover, in the year 2016, another 3,820 cases had been registered. High death rate is a main concern of the disease, where, according to the Presidential Task Force statistics 2,000 CKD/CKDu deaths occur annually. Studies had revealed that the prevalence of the disease in the North Central Province (NCP) where Ranbanda lives is four times more than that of other provinces. Though the cause for the disease prevalent in poor, rural, farmer communities in hot climates such as Central and Latin America, India and Sri Lanka is not yet established, dehydration during the dry season; exposure to cadmium, arsenic , lead and nephrotoxic pesticides through drinking water and food are considered to be the triggers. This is the story of a community in Polonnaruwa facing and fighting the disease with ‘clean’ drinking water.

First it was abdominal pain. Then came the fatigue. He could not work the paddy field as he used to. He had seen others suffering from the same. Misery and doubt welled in his heart. As the sole provider of his family, he had many questions to answer. What would happen to him? Would he be able to provide for them? And for how long? If he didn’t, who would provide for his family? A check up at the hospital in Kandy would give him the answers to some of his questions. However, without the wherewithal to sustain the journey alone to the hospital in Kandy, he had to wait till opportunity arrived in the form of a group of people from his village arranging a bus ride to Kandy. That’s how R.M. Ranbanda found he was suffering from Chronic Kidney Disease/Chronic Kidney Disease of unknown aetiology (CKD/CKDu).

Today, at 70, Ranbanda still survives. Moreover, his symptoms are “on the decline,” he claims. “I don’t get the stomach (abdominal) pains any more.” His wellness, he attributes to the “clean water from the society. Since I started drinking this water, I started feeling better. Now, we use this water for cooking as well.”

The ‘clean water’ Ranbanda receives is ground water from a nearby tube-well that had gone through the Reverse Osmosis (RO) process of water purification, which had been available to him since 2013. The ‘society’ he speaks of is the Nelum Samadhi Community Based Organisation (NS- CBO), in Yudhaganawa, Polonnaruwa. An amalgamation of 2 organisations from the Grama Sevaka (GS) divisions of Nelum Pokuna Gama and Yudhaganawa, the Nelum Samadhi CBO is involved in the task of providing drinking water and pipe-borne water for the community with assistance from the Asian Development Bank (ADB) and the National Water Supply and Drainage Board (NWSDB). The Rs. 17 M project, with a community contribution of Rs. 4 M had brought many benefits to the surrounding community as well as nearby GS divisions.

The CBO constructed the tube-well and 2 elevated water storage towers with the initial grant in a plot of land donated by a philanthropic community member, A.A. Kamalawathie Amarasinghe in 2011. They started providing pipe borne water to the community. Later, in 2013 with a grant of a Reverse Osmosis unit for water purification, they progressed into providing the community with safe water for drinking and cooking at a nominal cost. The CBO provides purified water free of charge to vulnerable members of the community.

Ranbanda and 42 other identified CKD/CKDu patients in the area are provided with 20 litres of purified water for drinking and cooking, free of charge by Nelum Samadhi CBO. The rest of the community get drinking water “at one rupee per litre on retail purchases and at 70 cents on bulk purchase. Almost free of charge, compared to purchasing one litrer of bottled water at Rs. 80-100 in the open market,” says G.P. Chaminda Preethikumara, Chairperson of Nelum Samadhi CBO. Their RO unit produces 15,000 litres a day, utilized by the community; purchased by institutions and distributed to other communities by private distributors who sell it in areas where purified water is a scarce commodity.

H.G.M. Warnasuriya is a businessman involved in the sale of purified water, who sees his business more “a service to the community.” His interest in protecting the environment, the pressing need of the community and the CKD/CKDu concerns drove him forward selling water. “I usually sell about 2,000 litres a day within the periphery of about 50Km, and more during the dry season. Most are householders, while there are some government and private institutions,” says Warnasuriya. He had first started the business with a rented lorry. “After sometime I thought it better to purchase a lorry of my own.” A vehicle loan from a government bank had enabled him to achieve his goal. His income selling a litre of water at Rs. 2.50 is “more than enough for the family and to pay the vehicle loan,” he says.

With the water, land value has increased substantially, opine the villagers. “Before the water project started, one acre of land could be bought with less than Rs. 20,000 and now, to buy 20 perches you have to pay about Rs. 500,000.” Many settlers had wanted to leave the area due to non-availability of water, especially during the dry season. M.G. Dhanapala an early settler in the community who came to Yudhaganawa in the 1970s, had wanted to leave the settlement many times. “We used to get the water from the canal from Minneriya tank. When the canal goes dry we would get the water from the school well. Many families left due to the water scarcity,” says Dhanapala. When the school well goes dry members of the community had to walk 1 to 1.5 Km for water. Therefore, paying Rs. 400 for the monthly water bill, with water at hand 24 hours a day is a minor expense.

At present “500 households receive pipe-borne water,” explains Preethikumara. When they had commissioned the project in 2011, the number of households were less than 200. “It was first planned only for the 2 GS divisions, Nelum Pokuna and Yudhaganawa with 18 km of pipe-lines. However, when people got to know about the water supply there were requests from nearby villages,” Now, they provide pipe-borne water for 500 households in 8 villages belonging to 4 GS divisions. The pipe line is extended to 32 Km from the initial 18 Km. Yet, “the demand is more,” he laments.

The CBO’s water project is sustainable says Kamal Dahanayaka, Senior Project Officer, Water & Urban Sector Projects, ADB Colombo Office. After the initial grant by the ADB, the CBO gets technical support from the NWSDB, but is financially independent. The CBO Chair is affirmative. Current average water consumption per household is 15 units (cubic meters) with a monthly bill of Rs.300 and for a new connection a household pays Rs. 20,050. The tube well provides 700 cubic metres of water per day issued to the community 24 hours. Even after providing water free of charge for CKD/CKDu patients, for those diagnosed with heart related diseases, at funerals, schools, temples and so on the CBO makes a profit, confirms Preethikumara. The only months they run at a loss are the months where they have to replace four filters of the RO unit, at about Rs. 40,000 each. The recovery rate of the CBO water bills are over 95 per cent, according to U.G. Kanthi Pushpalatha, Chief Clerk of the CBO. They won’t let any water bill go beyond Rs. 5,000 or keep the bills pending for over 2 months. “We send the red-bill, a disconnection warning in the 3rd month. They usually pay. Water is a precious commodity here. So far, there have been no disconnections,” she confirms. The CBO gets technical support from the Polonnaruwa Rural Water Supply Unit of the NWSDB, says Sadhya Yapa, Engineering Assistant who works closely with the CBO. In the Polonnaruwa district, as of end October 2017, there are 248 CBOs involved in water purification and distribution, of which nearly 40% (101 CBOs) is funded by the ADB.